recently infected with HIV and viral load is undetectable without medsJun 12, 2005

hi dr. frascino. i know this isn't the correct forum category for my situation, but in reading your responses, you seem to really care about everyone's concerns. your responses are always filled with much compassion, humor and wisdom -- i should have directed these questions to you in the first place. a little background info:

i was recently infected with HIV on feb 10 of this year. i experienced the onset of the seroconversion flu on february 26. on april 4, i had my first labs done: western blot positive, viral load was at 737 and CD4/CD8 ratio was at 0.77, with a CD4 absolute count of 642. i took my next set of labs on may 9 and it showed that my viral load was undetectable (<50 copies per mL), but my CD4 absolute count dropped to 617 and my CD4/CD8 ratio dropped down to 0.60. i'm not sure how to take this news since one marker went in the right direction (viral load dropping to undetectable), and the other went in the wrong direction (cd4/cd8 ratio and cd4 absolute count dropping). as far as the viral load goes, my doctor said that he wasn't surprised that my viral load dropped to undetectable, since my first set of labs indicated that i had a robust immune respone. he said this is great news, because without having taken any meds, my immune system was able to knock the viral load down to undetectable. i don't know how to take this news, though; so here are my questions:

(1) is it typical for the viral load to drop this low after having been recently infected? (2) how do i know when my "set point" has been established? (3) should i be concerend at this point about the cd4/cd8 ratio and cd4 absolute count dropping?

thanks so much for being so thorough in your responses to people. i know i'm certainly not the only one who appreciates the vast amount of knowledge and compassion that you share.

Response from Dr. Frascino

Hello,

It's always a bit difficult to comment without having all the necessary details, so I'll approach your questions from two different vantage points.

First, hypothetically speaking, it is not typical for the viral load to drop to undetectable levels following recent HIV infection. In fact, usually the opposite occurs: viral loads skyrocket and then the body's immune response kicks in and knocks the viral load down to the "set point," which is a kind of tenuous equilibrium between the virus and immune system. Should you be concerned about your CD4 count and CD4/CD8 ratio? Depending on where you had your lab tests performed, 642 and 617 may be "normal." Also, there is some variability in CD4 counts based on time of day and multiple other factors. Consequently, the difference between 642 to 617 may not be significant. The CD4 percentage may be a better indicator. The ratio drop from 0.77 to 0.6 reflects the changes in both your absolute CD4 count and absolute CD8 count. Again, it is subject to multiple variables. In general, it is best to have a rising CD4 count (into the normal range for your laboratory). A normal CD4/CD8 ratio is often quoted as 2:1 but the normal range depends on the laboratory you are using. For instance my laboratory presently lists the reference range (normal range) for CD4/CD8 as 0.86 to 5.0. One thing to consider when your laboratory tests aren't following a usual pattern is the possibility of laboratory error. A repeat test could resolve this potential problem.

Next, le me pose another scenario based solely on the information you provided. You report exposure on Feb. 10 and flu symptoms on Feb. 26. On April 4, you report your first labs as being a positive Western Blot and a viral load of 737. Did you have a positive ELISA test? If not, it's possible your Western Blot is a false positive. This would also explain your very low viral load becoming undetectable on your next blood draw. Consequently, the first thing to do, if you haven't done it already, is determine if you are HIV positive or not by getting an FDA-approved antibody test (ELISA). If negative, you are HIV negative. If that's the case, write back with the good news and we'll WOO-HOO together! If, on the other hand, you are confirmed to be HIV-positive, a repeat PCR RNA viral load should be drawn and you should establish care with an HIV specialist in your area. I'm here if you need me. OK?

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